Making the Switch from Omnipod to t:slim X2

I have been meaning to write about this one for a while, mostly because when I was trying to research the switch, I read a bunch of testimonies from other people who’d been willing to share about their reasoning, and it really helped us.

I want to preface this post by saying that in pretty much every sense, we couldn’t find anything fundamentally wrong with the Omnipod system. The tubeless insulin delivery was a dream come true (still is) and the freedom it gave our son was unmatched. The pods were easy to apply, easy to remove, and even easy to decorate. I should also say that we’ve been blessed with a loophole in our (otherwise not all that fab) insurance, which allowed us to switch pumps for our son before the warranty period was up. This was an unlikely but huge stroke of luck for us, and if it hadn’t been the case, we would have been happily continuing with the Omnipod for a good few years yet.

That being said, about a year into T1D-induced sleepless nights, I was losing the will a bit and honestly, something had to give. I’ve always found that if I’m struggling with something (like the fact we hadn’t slept in a year), the easiest way for me to feel better about that thing is to come up with a plan to change or improve it, and so late one night I turned to my husband (read: elbowed him awake) and declared that we needed a new plan. Pronto.

The thing is, Omnipod had always seemed like the obvious choice for our son for the following reasons:

1. The tubeless design, which allowed him the freedom to run around unencumbered, like the (basically feral) child he is.
2. The site changes are seamless, which is a must if you have a wriggler on your hands. The little guy barely had to linger around waiting for setup to be complete, and we could whack on the pod and activate the cannula insertion from a distance, which meant less pinning down for us/upset for him.
3. Minimal site change components and very low key steps: literally just the syringe/needle, the insulin, the pod and a few clicks. Hallelujah.
4. Accidental self-dosing seemed less likely, simply because it’s harder for our boy dose himself if he doesn’t have the dosing implement sat right on his belt. (Note: there is the “unlock” feature on the T:slim that requires you to enter “1, 2, 3” before it lets you in, but our kid is sharp and at 2 years old, he had a real penchant for unlocking each and every device he encountered. This, partnered with his toddler-typical lack of interest in listening to any adult guidance, left me feeling a little nervous).

But was it possible that things had changed? The more I threw myself into the T1D community and all the literature it provided, the more I read about advancing technologies. As I narrowed in on discussions about closed-loop systems and automatic corrections, my head began to turn.

I knew Omnipod were moving in the direction of being able to control dosing straight from your phone, and folks, I cannot overstate how much I am here for that idea. A closed loop system for Omnipod devices is also on the horizon (see what I did there?). But there were downsides to the Omnipod too:

1. Horizon (the Omnipod version of a closed-loop system) hasn’t yet been released. In fact, it looks like the release might even be later than originally planned.
2. Further to that, there is no current basal suspend option for impending lows with the Omnipod, meaning more work on our end (which is fine if you’re not walking around in an almost permanent zombie state, but here we are).
3. It’s a hassle having to remember to carry around another device (on top of the two children and all their drinks/snacks/toys/books/favorite sticks from last fall).
4. Our little guy (maybe?) found the Omnipod cannula insertion more painful than the t:slim one. This is totally subjective and our boy is not the most reliable witness ever, so take from this what you will.
5. Just a minor one, but sometimes this weird alarm goes off when the pod stops working, and the damn thing is really hard to make stop. I once called the customer service line in tears because my baby would not stop screaming and I couldn’t get the alarm to stop and I was this close to hurling it into the nearest puddle/river/lake. Pro tip: keep an earring or paperclip on hand and you should be good to go.

But the t:slim X2? Using its Basal IQ technology, it can lower your basal rates to prevent/reduce the severity of lows. Better still, Control IQ was about to come out (as it has now), and the feedback from the trial phases had been so overwhelmingly positive that I was blown away. Other pros of the t:slim seemed to be that:

1. It communicates directly with the Dexcom G6, meaning not only that it’s able to coordinate the Basal/Control IQ features, but also that you can see your or your child’s blood sugar on the screen when you go to dose. Super handy when you’re constantly losing the iPod that you read his Dex numbers from.
2. It has a slightly more user-friendly/streamlined interface. It feels more modern.
3. It dispenses insulin in smaller increments, meaning tighter control over corrections and meal bolusing. This is even more valuable when you have a tiny diabetic, and a little bit of insulin goes a long way.
4. Basal IQ. A quick glance at the t:slim at any given time shows just how many times Basal IQ has been activated throughout the day. For us (or specifically our 4 year old), it’s a lot. Does it always prevent lows? No. But are the lows less severe? For the most part, yes.
5. Control IQ, if you/your child is old enough to use it. In the majority of cases, reports seem to suggest that this feature is huge for improving time in range/A1C, and I’ve read a number of testimonies now about how it’s dramatically decreased the number of nighttime alarms <swoons>.
6. Excellent customer service. I mean this. We’ve had a handful of times when a slightly stressed me has had to call for help, and without fail the customer service has been on point. Better still, when you have a t:slim and a Dex, Tandem (the parent company) handles some Dexcom issues as well as pump issues. Not all the time, but for certain occasions (that I can never remember). We haven’t had a particularly bad experience with Dexcom (bar a lack of information when systems are down) and we love the device, but getting to deal directly with Tandem for this stuff too is an extra blessing.

After multiple weeks’ worth of late-night googling, I’d pretty much settled on the idea that t:slim had some serious advantages. But I still couldn’t figure out what would be best for our son.

At the time these switch discussions were happening, our boy was only 3. He’s now 4, but he’s still too young (by quite a way) for Control IQ, which is the biggest draw of the t:slim for us. Anecdotal feedback seemed to differ on whether the tube vs. Basal IQ trade off was worth it, and if I’m being totally honest, now that we’ve made the switch, I’m still not 100% sure it is. The major downsides of the t:slim that we’ve found are as follows:

1. The tubing (sort of). It would not be an exaggeration to say that I initially got super anxious at the idea of forcing our child to walk around wearing a tubed device, having allowed him the freedom of a tubeless one. Our kid, like most little ones, is a jumping, hopping, dancing mess of a human, and he does. not. stop. moving. The idea of him keeping on pulling out his site was a big worry for us, but it has happened only once since we got it just over six months ago, and that time was actually my fault because I accidentally got myself tangled up with him. Sorry, bud.
2. As I mentioned above, Basal IQ does generally reduce the severity of the lows, but it doesn’t prevent them. I think when we made the switch I was super hoping we’d get more sleep and I think perhaps we do, but it’s not a huge change. Saying this, he is 4 and with all the growth spurts the kid is all over the place, so that might be why we haven’t seen such breathtaking results. Super optimistic about the potential of Control IQ though, when it’s available to him.
3. I still worry that it’s possible (but unlikely) that a young kid could dose themselves if they can get through the (relatively primitive) 1, 2, 3 passcode entry. Thankfully, as he’s grown, we’ve been able to impress on our little guy the importance of never ever doing this but only because beneath it all, he’s (blessedly) a rule follower. I’m very much aware that if he did want to dose himself, even by accidentally pushing buttons, he could potentially find a way (although admittedly, he’d have to press quite a few buttons in a relatively coordinated effort).
4. There are a lot of necessary components and steps for each site change, which can be a bit of a hassle. Parts wise, on top of the usual insulin and syringe, you have the cartridge and the infusion set. Set up takes longer because there are more steps, and you need to be right in front of your child to insert the cannula. Set up is longer, but you do find your groove quickly enough.
5. The device often times out if you press in the wrong place more than 3 times. Great for keeping toddlers out of trouble, super annoying in the middle of the night when blood-sugar-alarm rage is at its peak.
6. Programming your “personal profile” (basal settings, correction factor, carb:ratio, etc.) feels slightly more long-winded and less intuitive than with the Omnipod.
7. Tandem (as far as I’m aware) have no immediate plans for moving to tubeless delivery or smartphone controlled dosing.

But is it worth it (for us) to keep on with the tubed pump until he can get the Control IQ feature? Yes. All the way.

It’s a tough one, folks. Do I wish we could have a tubeless, closed loop system right now? Of course. But the long and the short of it is this: if using the t:slim, tubes and all, means my son will be able to move to a closed-loop system sooner, I’m all for it. I’ll go straight onto the t:slim once I reach the point of insulin-dependency for the same reason – it’s my fastest route to an FDA approved closed loop system, and being real here, maximizing sleep for all of us.

If we took the closed loop system out of it, it would be close, but I think Omnipod would win. It all comes down to what you or your child needs most, and what trade offs you’re willing to make. It’s not an easy one. But if you have any questions about our experience that I might be able to answer, please do reach out.